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在EGFR突变肺腺癌患者吉非替尼或厄洛替尼治疗期间CNS转移的差异

2017年01月25日

编译：陈梦阁

来源：肺癌多学科会诊

CNS转移预后很差，所以EGFR突变肺腺癌患者使用EGFR-TKI治疗期间发生CNS转移非常棘手。一些研究结果提示吉非替尼[G](33-36.6%)和厄洛替尼[E](1.3-4.9%)治疗期间CNS转移的发生率可能存在差异目前尚无直接比较两种药物治疗期间CNS转移发生率的报告

本研究目的在于回顾性探索G和E治疗期间CNS转移的发生率

研究方法

回顾性分析2008-2014年间175例接受吉非替尼或厄洛替尼一线治疗的EGFR突变肺腺癌患者

*CNS进展定义：检测到新发CNS转移或在接受EGFR-TKI治疗期间已存在的CNS病灶进展

研究结论

本研究结果显示TKI治疗期间，厄洛替尼组CNS PD率低于吉非替尼组。

在EGFR-TKI治疗前无CNS转移的患者中差异显著

相对吉非替尼，厄洛替尼治疗可能预防EGFR突变肺腺癌患者发生CNS转移

P2.03B-017 DIFFERENCES OF CENTRAL NERVE SYSTEMMETASTASIS DURING GEFITINIB OR ERLOTINIB THERAPY INPATIENTS WITH EGFR-MUTATED LUNG ADENOCARCINOMAK

azushi Yoshida1, Shintaro Kanda1, Hideaki Shiraishi1, Keiko Goto1, KotaItahashi1, Yasushi Goto1, Hidehito Horinouchi1, Yutaka Fujiwara2, HiroshiNokihara1, Noboru Yamamoto1, Yuichiro Ohe1

1Thoracic Oncology, National Cancer Center Hospital, Tokyo/Japan, 2Department ofExperimental Therapeutics, National Cancer Center Hospital, Tokyo/Japan

Background:

A few reports have suggested a difference in the incidences of new metastasis to the central nerve system (CNS) during gefitinib anderlotinib therapy. However, a direct comparison of these two therapies hasnot yet been reported. We planned a retrospective study to investigate theincidences of CNS metastasis progression (new CNS metastasis or progressionof existing CNS metastasis) during gefitinib and erlotinib therapy in patientswith non-small cell lung cancer (NSCLC) harboring EGFR mutation.

Methods:

We retrospectively analyzed the incidences of CNS metastasis progressionand the outcomes of NSCLC patients harboring EGFR mutation who receivedgefitinib or erlotinib as a first-line EGFR-TKI treatment at the National CancerCenter Hospital between 2008 and 2014.

Results:

A total of 175 patients were analyzed; 148 patients had received gefitinib, and 27 had receivederlotinib. The median (range) ages were 64.5 (32-81) years and 62.0 (27-68)years, respectively; exon 19 deletion/L858R point mutations were present in84/64 (56.7%/43.3%) and 17/10 (63.0%/37.0%) cases, respectively. The statusof CNS metastasis before EGFR-TKI therapy was negative/positive in 105/43(71.0%/29.0%) cases in the gefitinib group and 21/6 (77.8%/22.2%) cases in theerlotinib group, respectively. The incidence of CNS metastasis progression inthe gefitinib group tended to be higher than that in the erlotinib group (29.0%vs. 11.1%; P = 0.051). In patients without CNS metastasis before EGFR-TKItherapy, the incidence of new CNS metastasis during EGFR-TKI treatment wassignificantly higher in the gefitinib group than in the erlotinib group (24.7%vs. 4.8%, P = 0.04). The progression-free survival (PFS) and overall survival(OS) periods of the patients who presented with CNS progression wereshorter than those of the patients who presented without CNS progression(median PFS, 9.5 vs. 12.6 months, P = 0.034; median OS, 23.8 vs. 34.1 months, P= 0.002). Fifty-six patients underwent re-biopsy after the failure of EGFR-TKItherapy, but no difference in the incidences of EGFR T790M mutation wasseen between patients with and those without CNS metastasis progression(40.0% for patients without CNS progression vs. 63.6% for patients with

CNS metastasis progression, P = 0.19).

Conclusion:

The incidence of theprogression of CNS metastasis during gefitinib therapy was higher than thatduring erlotinib therapy. In addition, the difference in this incidence was moreremarkable among patients who had not developed CNS metastasis prior tothe start of EGFR-TKI therapy.

Keywords: EGFR-mutated NSCLC, Erlotinib, CNS Metastasis, gefitinib

参考文献：

Yoshida K, et al. 2016 WCLC Abstract P2.03b-017.

编辑：肿瘤资讯-小编